Pneumonia, the giant killer

Few experiences can be more wrenching than watching a child suffer illness or injury. As doctors, the emotional trauma — and we can think of no more apt expression — is much more intense when we are faced with a tiny patient, a little child who need not have suffered at all, and whose ailment was eminently preventable. Often this occurs because of lack of knowledge on the part of the parents or society at large — and it could as easily happen to a poor family as to a well-off one.

Take the example of young Srivats, all of four years who went through the ordeal of pneumonia. His schoolteacher mother and businessman father are reasonably well-off Bangalore residents. Their son reported frequent cough and fever. One day, alarmed at Srivats’ fluctuating temperature, his patents took him to a doctor who prescribed medicines. The boy recovered only for a day; and the fever returned.

A few mornings later, Srivats woke up shivering. His parents rushed him to a nearby hospital but were left unsatisfied, as the diagnosis didn’t reveal any obvious reason for their son’s illness. Pneumonia was confirmed after a second visit to the hospital. 

Srivats’ parents were in shock, and denial. Not in their wildest nightmares had they imagined that their much-protected, much-loved son would contract pneumonia.

After three days of hospitalisation and a course of treatment, Srivats recovered.  
It was a feeling Nagesh, a weaver from Doddaballapura, and his wife Shwetha, would understand. Just 16 months old, their little girl Tejaswini, had a dream first year. Healthy and cheerful, she was the life of her family. Just after she turned one, Tejaswini developed a wheezing problem. It left her cranky and stopped eating. Her parents took her to a nursing home where she was put on a nebuliser, which sprayed medicine in a fine mist into her lungs. It was a strong regimen for a one-year-old and even after two months there was no improvement. She was moved to another clinic where the nebulisation course was repeated. 

She came to the hospital after four months of nebulisation when Tejaswini was diagnosed with pneumonia. The disease was in an advanced stage and Tejaswini spent six days in the pediatric Intensive Care Unit. Treatment saved her.
The two children are among the lucky survivors. Each year, pneumonia kills 4,00,000 Indian children under the age of five — that’s more than measles, malaria, HIV/AIDS and injuries combined.

Children from less well-off families are at increased risk of developing pneumonia. Poor nutrition, indoor air pollution and crowded living conditions make them more vulnerable. Exposure to cigarette smoke is a major risk factor. Crucially, this is a disease that can be prevented.

The most common causes of bacterial pneumonia among children in India are two organisms: pneumococcus (Streptococcus pneumoniae) and Haemophilus influenzae type b (Hib). Together, they account for half of all pneumonia deaths. Safe and effective vaccines are available for Hib. New vaccines against pneumococcus are likely to be available shortly.

Pediatricians and the IAP (Indian Academy of Pediatrics) have been propagating the use of both vaccines, but to have an impact, widespread use among the most susceptible population is essential.

A start has been made by the Union government’s National Technical Advisory Group on Immunisation (NTAGI), which has suggested bringing the Hib vaccine into the Universal Immunisation Programme in 2009. NTAGI has also recommended India begin introducing the next generation pneumococcal vaccine by 2010. 

Of course, vaccines alone are not enough. There is no one magic wand. Pneumonia control requires a multi-pronged approach including reducing risks, appropriate treatment and vaccines.

The author is a consultant pediatrician
at Manipal Hospital